Disseminated strongyloidiasis in immunocompromised patients--report of three cases

Int J Dermatol. 2009 Sep;48(9):975-8. doi: 10.1111/j.1365-4632.2009.04082.x.

Abstract

Background: Strongyloides stercoralis is an intestinal nematode of humans. The characteristic cutaneous manifestation of strongyloidiasis is larva currens. Patients with suppressed immunity can develop a severe disseminated strongyloidiasis involving wide spread of the larvae to extraintestinal organs, outside the usual migration pattern. Patients with cell-mediated immunodeficiency and on corticosteroid therapy appear to be at highest risk for the development of this highly fatal entity.

Methods: We present three patients with disseminated strongyloidiasis. All patients were immunocompromised and were undergoing corticosteroid therapy. Physical examination revealed a rapidly progressive purpuric petechial eruption with a reticulated pattern, mainly over the abdomen.

Results: The histopathologic findings of the skin biopsies revealed a purpuric lymphomonocytic vasculitis that compromised the superficial dermis. In one skin biopsy, a larva was identified. None of our patients had eosinophilia. Strongyloides stercoralis was isolated in the fluid of the three patients, either before or after they died.

Conclusion: The risk of disseminated strongyloidiasis in patients with impaired cell-mediated immunity is unknown; however, given the poor prognosis of disseminated strongyloidiasis, consideration should be given to the screening of patients at increased risk of infection.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Female
  • Humans
  • Immunocompromised Host
  • Male
  • Middle Aged
  • Strongyloidiasis / diagnosis*